At Dying Beds

At dying beds I’ve experienced a lot of silence – which felt at times good, at times disturbing. Dying people will be almost always be in coma in their last hours (and, mostly, days). What hinders us from speaking with the dying?

  • As family members, we may be in a shock state, frozen or confused.
  • We may be insecure if they hear and understand us.
  • We may be insecure what is relevant and helpful for them.
  • We may feel insecure what the staff thinks of us if we behave unconventional.
But surely, if we find out what hinders us from speaking and acting, this can free us and widen the range of our possibilities, to the benefit of both ourselves and the patient.

Sometimes it’s extremely difficult to notice and interpret any nonverbal reactions of coma patients. In other cases we need to sharpen our senses. With no other body reactions left, often there are still reactions on our words, or on caressing, in the patients’ changing his of breath style and rhythm (unless on a breathing machine).
If we do find tiny nonverbal reactions or changes of the way of breathing, the questions are:

  • Does the patient show this behavior repeatedly (every time) when we bring up a certain topic or do something particular (or when a certain person is arriving or leaving or being mentioned)?
  • Do we rather see the reaction as one of stress or relief?

I would like to summarize a few things that I have learned from the Encounters I had with dying people.
1. Treat dying people as living people.                                                                              2. At a dying bed, get aware of what hinders you from acting and speaking free. Free yourself to get flexible.
3. Observe which tiny reactions (movements, mimics, breath) the dying person shows repeatedly on certain key words, persons, behavior. Are they reacions of stress, relief or interest? Which are the triggers?
4. Dying patients may be in coma, but they’re usually not deaf. Choose your words well. No catastrophic medical descriptions or burial talk.
5. Create rapport. Introduce yourself and tell your aim shortly. Use body contact, use your voice and breath pacing.
6. See a coma patient as someone who is already in trance. Create rapport. Interventions can start right away, without induction
7. The subconscious responds strongly to imagery. Speak in a dream language. Use metaphors, avoid abstract words.
8. Breath pacing and leading can regulate pain or breath problems (and can regulate breath down till it almost stops).
9. Breath, blood pressure and heart rate can also be regulated by metaphors (f. e. of a flying eagle, a pulsating jellyfish or a manta ray).
10. Speak about emotional content rather than about facts.
11. Express in metaphors or more directly that it is possible and good to let go – of live, of psychological problems of body problems.
12. Use metaphoric terms to speak about the good future.
13. Introduce thoughts like “You can love them from the other side”, “things will change, relations go on”.
14. Use negative terms only with a good reason. Except for pacing strong pain, don’t mention “pain” but “body sensations”. Teach this to the relatives.
15. People will rather die when they’re ready to go. What may help: Rituals, a bye-bye from family members, messages of “letting go”.

The Good Shepherd

I would like to say something about breath pacing, and about texts that we can recite to a dying Person.
I knew Mrs. Seiberth, and we had liked each other. I knew that she was a religious woman and that she wished that her son would come and see her. Asked why he doesn’t come she said: “He’s living far away. – But also, he is afraid of seeing me so sick.” When I was visiting her now she was in coma. She looked into an empty space. With every breath she made a coughing sound. I put my hands on her arm. Calm and slowly, with long pauses in the pace of her breath I recited the psalm of the good shepherd. Her breath went calmer and the coughing noise went silent. But at the words “thy rod and staff they comfort me” the coughing came back. Maybe they reminded her of something that made her sad? The concept of systematic desensitation of fears came to my mind. So I repeated these very words so often in a very calm and friendly tone till the coughing disappeared again. Then I continued. At the words “in the presence of my enemies” the coughing came back. I did the same procedure of repeating the words in a friendly tone till the coughing was gone and she was breathing calmly. At the words “Goodness and mercy will follow me all my life” her breath got even calmer. So I repeated these words many times till it got even calmer. I finished the Psalm and said “I would like to say bye-bye now.” Immediately the coughing noise came back and continued with every breath. “I will come back, I will come back, I will come back…” I said, and the noise disappeared. The next day I visited her I read the same psalm to her. Her breath was calm and silent all the time. Only when I said that now I would leave the coughing noise came back. “I come again, I come again, I come again…” I said till it was calm again. The next day I was about ninety minutes later than on the previous days. Entering her room I saw a man who introduced himself as her son. “She’s died an hour ago.” He said. „Was she still alive when you came?“ „Yes“, he said. (Stefan Hammel, Handbook of Therapeutic Storytelling, Karnac, London 2017/18)

The Cloak Room

Noticing that the man I mentioned yesterday died so soon after my visit I got curious about the effectivity of the cloak room metaphor.

I remember I was called to the bed of a dying woman. When I arrived she was breathing about once per minute. I didn’t know that a person could breathe so little and still be alive. Her daughter and her son in law were there. I asked if it were appropriate to speak a prayer, to which they said “Yes”. After telling the dying woman that her daughter and son in law were there, who I was and what I was going to do I put my hand on her arm and spoke a prayer. Then I said to her: “I would like to tell you something, Mrs. S. I imagine there’s a door. When it will be the right time for you, you can go through that door. Next to the door there’s a cloak room. There’s someone who can have an eye on your things so they’re safe. It’s a special wardrobe. You can had in anything that’s a burden to you.
If you’re afraid – take it off. You don’t need any fear over there.
If you’re sad – hand it in. For what? You don’t have any use for that now.
If you bear a grudge or haven’t forgiven someone – hang it on the big wardrobe.
If you feel obliged to anything – take it off.
If you think you need to stay – there’s nothing you need to! If you want, give it to the one who’s standing there for guarding it.
If you think there’s still something left to do or that there’s anything missing – hand it in to the one who will guard it for you.
If there’s anything unpleasant in your body – give it to him as well.
If there’s any problem with breathing – give it to him as well.
If there’s anything else you would like to give to him – hand in anything that you don’t need any more.
Give him anything that has become a burden for you. Take it off. You don’t need it any more. And when you notice that it’s time for you, go through the door.” I finished with a blessing.
During the prayer the breath frequency of the woman had gon up to about six breaths per minutes, and thus it stayed for a while. Her daughter and son-in-law were observing her breath silently. The silence felt somewhat heavy for me and I had the imagination it could be the same for the dying woman. So I asked: “Can you tell me what happened so your mother got in this state?” The daughter said a few sentences. Her mother’s breath got very slow again. After five breaths there was a very tiny one. Then everything was still. (Stefan Hammel, Loslassen und leben. Impress, Mainz 2016)
I’ve used this metaphor a number of times now. Often the effect seemed to be very strong. The structure is thus: There’s door and a cloak room and an attendant next to it. You say: Whatever burdens you concerning the past: Hand it in. This can be specified as a bad conscience or anger against someone else or sadness about something that happened. Whatever burdens you concerning the future: Hand it in. This could be specified as worries about the relatives or about what comes after death. Whatever burdens you concerning the present, hand it in. This could for example be specified as a discomfort of the body (pain) or breathing problems.

On the Effects of Last Rites

In my work as a chaplain I have been at many dying beds. I find it notable that people don’t want to call the pastor unless their Family member is really dying. Maybe they think that when the pastor’s been there, there’s no way back. You could take that as a superstition. But there’s some evidence that they may be right. I’ve seen people survive when the medical staff said they would die in the next few hours. I’ve seen one person survive for three days after the doctor told the relatives that according to brain death diagnostics the patient is already dead. I have not seen a single person survive after the pastor was there for a last prayer. I remember saying to a colleague: “I’ve always got a bad conscience. I feel as if I’m killing these people with my prayers. They all die within hours after I’ve been there.” He replied: “Oh, you as well?”
I remember being at a dying bed of an old woman. She was in coma, had an oxigene mask but still had trouble breating. There were about eight relatives around her bed, a tight-knit family clan. I spoke with them and I did a little ceremony. When I spoke the Lord’s prayer everyone spoke it with me real loud. It was quite a powerful experience. After I left the room one of the relatives said to me: “Did you see? When you came her heart rate was at 90 but during the Lord’s prayer it was at 140.” The nurse said: “It can take hours or days, we don’t know.” I remember answering: “It’s a strange thing. Mostly people die within hours after these prayers.” She left that uncommented. 15 min later I got a phone call that the lady had died and the relatives wanted to see me once again. The same nurse opened the door. “I had to think of your words”, she said.

Luís

Yo todavía era niño. Pero también si hubiera sido mayor, no habría podido decir como el carpa se hubiera explicado a si mismo su curioso viaje. Es que algunos amigos míos se habían permitido una jugarreta con él. De noche, clandestinamente lo habían sacado de su estanque con una red. Lo habían llevado en un cubo a través de bosques y campos por muchos kilómetros. La piscina en el jardín de mis padres debería ser su nuevo hogar. Tengo que admitir: No fue poco nuestro asombro cuando lo vimos nadando sus rondas en el agua. Me parece que fue en septiembre. Ya no se echaba cloro al agua, la temporada de nadar casi se había acabado. Entonces pez y ser humano ya no se hacían tanta competencia el uno al otro, y así Luís, como lo llamamos, podía quedarse allí por el momento. Vino el invierno y con él una espesa capa de hielo.
En la primavera, el agua fue cambiada. Como se puso en manifiesto , Luís había superado bien el invierno. El consejo familiar acordó devolverlo a su hogar. Otra vez Luís fue despachado en un cubo. Lo más grande que pudimos encontrar era un cubo ya inservible de pintura. Siguiendo caminos de bosque y de campo, nos fuimos para devolverlo a sus amigos y familiares. En el cubo, Luís dio sus vueltas, en círculos bastante pequeños, porque había crecido durante el invierno, y un viejo cubo de pintura no es una casa señorial para un carpa. Encima de eso, la mitad del agua se nos derramó a lo largo del camino. Pero finalmente llegamos. Con un empuje Luís acabó en su estanque para reencontrar sus viejos conocidos. Lo que hizo después fue muy sorprendente: Luís dio sus vueltas allí, pero lo hizo como que si no se encontrara en un estanque sino en un pequeño cubo, como antes. Trazó seis o siete círculos de un diámetro inferior a medio metro. Después los círculos se convirtieron en una espiral, estrecha al inicio y ampliándose más y más. Finalmente Luís comprendió donde se encontraba. En una larga línea se disparó fuera de su órbita de cubo.

(Por Stefan Hammel, traducción: Bettina Betz)

Snail and Vole

A story by Katharina Lamprecht

A vole watched a snail, which dipsy-doodled along a path and asked her: “Why do you crawl so arduously back and forth? Doing that it takes you much longer to get forward”. The snail sighed. “That’s true, but I always look on both sides of the path for something to eat. When I´m on the left side I keep thinking, that there might be better food on the right. When I´m on the right side I think the same and therefore go back to the left. I´m always afraid that I will overlook some yummy greens”. The vole understood perfectly. “I´ll help you. I´m a big taller than you are and walk in the middle of the path, that´s a good lookout. You can stay on the right side and in case I see something worth coming over to the left, I´ll let you know”. And in this way they went on. The vole saw many lush and juicy herbs on the left side, but it didn’t say a word. Because now, giving all her attention to just one side of the path, the snail found enough treats. After a while, as the snail discovered that she found enough to eat, she thanked the vole for the help and went on by herself. Just following her path.

La flor en la isla

En una pequeña isla en medio del océano extenso crecía una hermosa flor amarilla de oro. Nadie sabía cómo había llegado allí, porque en esta isla no había ninguna flor aparte de ella. Las gaviotas venían volando para contemplar este milagro con asombro. “Es linda como el sol”, decían. Los peces venían nadando. Levantaban las cabezas encima del agua para admirarla. “Es linda como un coral”, decían. Un cangrejo salió a la tierra para mirarla. “Es linda como una perla en el suelo del mar”, dijo. Y todos venían casi cada día para admirar esta flor.

Un día, cuando volvieron para contemplar la flor, se encontraron con que los pétalos dorados de la flor se habían vuelto marones y secos. “Ay de nosotros”, dijeron las gaviotas, los peces y el cangrejo. “El sol quemó nuestra flor. ¿Quién ahora nos refrescará el corazón?”. Y todos se pusieron tristes.

Pero algunos días más tarde apareció en lugar de la flor una maravillosa bola de color blanco tierno. “¿Qué es eso?”, preguntaron los animales. “Es tan blando como una nube”, dijeron las gaviotas. “Es tan ligero como la espuma de las olas”, dijeron los peces. “Es tan fino como el resplandor del sol en la arena”, dijo el cangrejo. Y todos los animales se alegraron.

En este momento un golpe de viento barrió la isla y sopló este milagro blanco dispersándolo por ella en miles de copos. “Ay de nosotros”, hablaron las gaviotas, los peces y el cangrejo. “El viento ha dispersado nuestra bola. ¿Qué alegrará nuestro ánimo ahora?” Y todos estaban tristes entonces.

Un día por la mañana, al levantarse el sol sobre la mar, allí en la luz dorada matinal relucieron cientos y cientos de hermosas flores color amarillo de oro. Entonces bailaron las gaviotas en el cielo y los peces en el agua, y el cangrejo bailó con sus amigos una danza de rueda en medio de las flores, y todos se alegraron.

(Por Stefan Hammel, traducción: Bettina Betz)

Midsummer Night’s Dream

Another beautiful story by Katharina Lamprecht

One day, it was Midsummer and the Swedish days where as long as the dinner table for the king’s birthday. A wise old moose on his evening stroll met a young boy, sitting on a moss covered tree trunk, sobbing deeply. The old moose stopped and looked at the boy who did not notice him because of all his despair. Not until the moose nudged him with his soft muzzle did the boy raise his eyes. And just in front of him he saw the big brown eyes of the moose. He saw in those eyes all the stars in the heavens that he could not see before on this Midsummer night. So big, so deep and so endless the eyes seemed to be that he got the feeling he could just take a walk right into them. The stars where so beautiful, like jewels, iridescent and glittering in all colors he could imagine, scattered like the crumbles on grandma’s apple-pie, big ones and small ones, thick and thin ones, each of them meaningful and unique. At the sight of all those treasures the boy got the feeling he was surrounded by good friends, who bestowed upon him potency and love.

So they stood for a long time and looked at each other, the young boy and the old moose. Then the moose blew his warm and soft breath through the boy’s hair, turned around and faded into the forest. The boy looked after him for a long time, as if in trance, and only after a while did he discover that his infinite sadness had transformed. It was still there but all of a sudden there was also a happiness and cheerfulness. And he somehow felt that this had something to do with the stars he had seen in the fathomless eyes of the old moose.

He turned around and walked back home. And whistling happily away he kicked at the stones that laid on his way.

The Crooked Bird

Another contribution by Katharina Lamprecht who will also be at the Festival in October

Sometimes there is a little sparrow sitting on the clothesline in front of my kitchen window. I like to observe him, he is quite funny and quite different than the other birds. Somehow he always looks as if he was a little tipsy. He dithers a bit on the line and you can see that it takes an effort to keep his balance because he sticks out one leg and flaps his wings. He generally makes the impression of being quite dizzy. But it doesn’t seem to bother him at all, on the contrary, I get the feeling that he enjoys his slanting position very much.

A friend of mine, who is an ornithologist, said that this phenomenon goes by the name of “crooked bird”, common knowledge amongst experts. He explained, that there are indeed many birds, who love to frolic through storms and high winds. Back and forth, up and down, left and right they let themselves dash around by the wind until they don´t know anymore where they are, don´t know up from down or back from forth. And it is obvious that they have so much fun with it, that they keep the dizziness even when there is no wind at all. Just like the sparrow on my clothesline.

Scientists suspect that these crooked birds have a kind of inner anchor. Somewhere in their bodies has to be a place that gives them the needed security to be able to always find their way and relate to a stable, secure, safe and unshakeable point, no matter what. In this way they can relax, be calm and at ease, at least internally. They can feel straight and upright even if they have no orientation in the outer world. The scientists cannot determine where this inner anchor is but they are quite sure, it´s there. Perhaps one can compare it to the radar that bats use. This we can´t see either but there is no doubt it´s there.

“We don´t really know how all of this functions, but it has to be somehow like that”, my friend said and grinned. To be honest, I´m not quite sure if I can believe his story or if he wanted to pull my leg. But watching my little sparrow, reeling and rocking with obvious delight on my clothesline, I keep thinking that he surely must have such an inner anchor. Even if he has not the slightest idea, where it is or that it even exists. But it´s got to be in there somewhere, an area within him that gives him the absolute certainty to be safe and sound in all of these dizzying situations. An anchor that keeps him upright and gives him balance.

So seeing him on the line, I imagine that, the more he careens, the bigger and stronger the anchor in him gets and he is even more centered. With stormy winds outside and the feeling of security and safety inside, the little sparrow can enjoy his crookedness as much as he likes. And I wonder, where my inner anchor might be…

Le village de montagne

J’ai demandé à un client : « Si vous voulez, imaginez-vous une fois votre vie comme un village de montagne, dans lequel le fleuve a débordé et a amené beaucoup de boue et d’éboulis. Après ce malheur le conseil municipal se réunit avec les villageois, les pompiers et la protection civile et ils discutent de ce qui est à faire. Il arrive tout d’abord des gens avec des pelleteuses, des bulldozers et des camions pour enlever le plus gros des éboulis. Pouvez-vous vous imaginer cela ? » « Oui. » « Vous pouvez voir comment ils déblaient tout ça. Après l’équipe de rangement il arrive des gens avec des tuyaux et des balais. Ils enlèvent toute la boue et le sable du village, toute cette saleté qui est venue de l’arrière-pays. Vous pouvez voir comment ils font tout couler vers le bas dans la vallée. Vient ensuite l’équipe des artisans. Il y a des maçons, des plâtriers, des peintres, peut-être aussi des électriciens, des installateurs, des stucateurs, des restaurateurs. « Que font-ils d’après vous ? » « Ils peuvent plafonner ou cloisonner. » « Exact. Quoi d’autre ? » « Poser une moquette. Câbler. Placer des tringles à rideau. » « Exact. Après les artisans arrivent les jardiniers. Ils aménagent de nouveau les parcs et les jardins. On rajoute peut-être un puits au village ou un tilleul au village pour améliorer encore plus le village, pour qu’il soit mieux qu’avant. Et un monument commémoratif. Peut-on imaginer cela ? » « Pas très bien. » « Eh bien, vous n’avez pas besoin de vous imaginer tout ça. Dites bonjour à votre âme, pour qu’elle fasse ça pour vous, comme ça vous n’avez pas à vous en occuper. Après il y a des personnes très importantes qui arrivent. C’est l’équipe de prévention. Ce sont eux qui veillent à ce que cela n’arrive plus. Ils peuvent planter la pente au-dessus du village par exemple, pour que les racines des arbres fixent la terre. Ils peuvent construire des murs et des grillages dans le style d’un paravalanche. Ils peuvent creuser un lit plus profond pour le ruisseau, peuvent construire des marches de barrage et des bassins de retenue ou même une déviation pour l’eau du ruisseau qui est de trop. »